There's constructive criticism and there's effective management.
But at this stage in the health insurance bill negotiations, this latest tweet from President Donald Trump is really neither:
A day after the election, six months ago, or maybe even six weeks ago would have been a better time for the president to send out this message. But now we have to ask what is "the right thing" exactly? And why is this the "last chance?"
And what about Senate Majority Leader Mitch McConnell? He's not exactly sending out a clear or powerful message either right now as the GOP senators he supposedly leads don't at this moment even know what they're supposedly voting on Tuesday. Is it an actual health insurance bill? Is it just an Obamacare repeal? Or is it just a motion to consider an Obamacare repeal bill?
What a mess.
When the team doesn't really even know what the coach is asking them to do, it's time for a new coach and/or a new strategy. And even with President Trump and McConnell keeping their current titles, that new team and strategy can and should be set into motion.
First, it's important to remember the biggest reason why the Republican efforts to repeal and replace Obamacare this year have been such a failure. The problem is that McConnell has been acting all along as if his main job is preserving the indirect subsidies the health insurers get from Obamacare. That's something he should have been working to eliminate, not keep alive.
That's kept the more conservative senators like Rand Paul and Mike Lee unwilling to support all the versions of the bill McConnell has been pumping out since the spring.
Another conservative, Senator Ted Cruz, was also not going along until McConnell recently agreed to add Cruz's amendment to allow consumers to buy bare-boned or "major medical" insurance plans again as they did before Obamacare became law. While it was encouraging from an anti-crony capitalist point of view that the insurance industry immediately blasted the Cruz plan, adding it into the bill seems to only have brought Cruz and not the other conservatives on board.
And the elephant in the room for the GOP, (no pun intended), is the bill's continued phasing out of the Obamacare Medicaid expansion and some other changes to Medicaid. As many as six Republican senators, most from states that accepted the Obamacare Medicaid expansion, are not going to support that idea as is. This wing is often described in media reports as "moderate Republican senators," but in reality they are simply the "Medicaid senators" and their fear of losing this relatively new federal entitlement for their constituents is anything but moderate.
It's clear that McConnell needs to yield to Sens. Paul and Cruz to shore up the conservative wing of the party. Between Cruz's plan to allow the return of cheaper policies and Paul's plan to allow all groups from churches to trade groups to pool their resources to buy regular and catastrophic insurance plans, they jointly represent the best way to take this crony capitalist, pro-insurance company process away from McConnell. Giving them the reins isn't just about shoring up conservative support, it's about diminishing insurance company dominance of our health care and fixing one of the things that was most wrong about the American health coverage even before Obamacare became a reality.
Senate Republicans need to make this change on their own. General pressure from the Trump team to make progress is OK but McConnell's failures on this matter have mostly put Republicans in Congress in electoral danger and they're the ones who should stop complaining about what is and isn't in the bill and change the management.
As for those senators who are digging in because of Medicaid, that's where the White House comes in because that's a federal program administered by President Trump's appointee. He can keep cheerleading but it would be more helpful if President Trump had something more specific to push and offer these holdouts. He might have that in the form of a plan that Medicare/Medicaid Chief Seema Verma is just beginning to pitch. It would reportedly use Medicaid funding and other federal aid to help people who won't qualify for the program anymore buy private insurance. The president could also call on senators to supports the policy Verma implemented in Indiana where Medicaid recipients had to put $1 to $27 per month into health-savings accounts in return for some free and guaranteed annual services. And the GOP could also take a page from the House Budget Committee and call on the states to make able-bodied Medicaid recipients fulfill some work requirements. All of the above are the kinds of specific things President Trump and the White House would do much better to promote rather than the ambiguous-to-useless message of "do the right thing."
And there's also a very simple option I and many others have pushed for weeks: Just take Medicaid out of this equation for now, leave the expansion alone for another year or two and just focus on those changes to the individual market. That would give everyone more time to properly sell the very difficult process of taking away or reforming an entitlement, even if that entitlement is a Medicaid expansion that's only been in effect for a few years. President Ronald Reagan used to provide that leadership to congressional Republicans when he often advised them to make compromises in one session and hope to get the rest of what they wanted a year or two later. It's time for President Trump to help the Senate Republicans help themselves in a similar manner.
The most helpful thing President Trump may have said during this entire process came last week when he urged Congress not to go into recess until a health bill is passed, saying "We have to stay here. We shouldn't leave town, and we should hammer this out and get it done." But now he needs to go further and give them a more specific reason to stick around while the Senate Republicans provide him with a team that can actually get results.
Commentary by Jake Novak, CNBC.com senior columnist. Follow him on Twitter @jakejakeny.
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